Bioterrorism On Our Doorstep: Bioterrorism has now been defined as the intentional use of a pathogen or biological product to cause harm to a human, animal, plant or other living organisms, to influence the conduct of government or to intimidate or coerce a civilian population.
Nearly forty newly emerging infectious diseases were identified during the thirty years between 1973 and 2003. And more may already be on their way to America. On February 16, 2006, a 44-year-old man presented to a hospital in Pennsylvania with respiratory symptoms including dry cough, shortness of breath, and general malaise and later tested positive for Bacillus anthracis, more commonly know as Anthrax.
He’s just one out of millions of people and goods that traverse the globe daily that could be dispersing microbial threats in their wake, usually without much notice. Living things get infected along the way, and the lag time before signs and symptoms appear can be days, weeks, or even months. This normal occurrence in our lives favors the emergence of new diseases and the re-emergence or increased severity of known diseases.
Meanwhile, the risk of bioterrorism has become a pressing national security issue. Taken together, these factors have stimulated calls for greater vigilance about microbial threats of public health significance showing up at our doorstep. Some of those calls have focused attention on the number, and more importantly the role of quarantine stations for human disease at our ports of entry.
The Secretary of the Department of Health and Human Services (DHHS) has statutory responsibility for preventing the introduction, transmission, and spread of communicable diseases from foreign countries into the United States and its possessions. The secretary develops and enforces regulations through the Center for Disease Control and Prevention (CDC). The CDC has authorized its Division of Global Migration and Quarantine (DGMQ) to carry out many of these regulations through a variety of activities, including the operation of quarantine stations at select ports of entry and the administration of regulations that govern the movement of people, animals, cargo, and conveyances into the United States. For example, DGMQ can detain, medically examine, or conditionally release individuals at U.S. ports of entry who are reasonably believed to be carrying a communicable disease of public health significance. Also, DGMQ and CDC can set policies to prevent certain animals that pose a public health threat from entering the country.
The CDC has quarantine stations at only a few of the 474 U.S. ports of entry. Unlike their namesakes, today’s quarantine stations are not stations per se, but rather small groups of CDC inspectors located at major U.S. airports. Their core mission remains similar to that of old: mitigate the risks to residents of the United States posed by infectious diseases of public health significance originating abroad. These quarantine station staff, their offices, and their patient isolation rooms are run by CDC’s DGMQ. The number of CDC facilities will be increased to 18 in FY 2005; still more will be added in FY 2006.
Each quarantine station is responsible for many ports of entry without a quarantine station located within a specific geographic area. For example, Hartsfield International Airport in Atlanta has jurisdiction over all ports in Georgia, Alabama, Arkansas, Louisiana, Oklahoma, Mississippi, North Carolina, South Carolina, and Tennessee.
The outbreak of SARS in 2002 dramatically demonstrated the need for strong, well-coordinated national and international systems for disease surveillance, detection, and response. Coupled with other microbial threats, SARS generated enough political will for the U.S. federal government to commit funding to biosecurity initiatives. A portion of the fiscal year 2004 budget appropriation went to DGMQ for the construction of three new CDC quarantine stations at U.S. ports of entry: Houston Intercontinental Airport; the Mexico–U.S. land border crossing in El Paso, Texas; and Dulles International Airport, located twenty six miles from Washington, D.C.
President George W. Bush proposed further expansion of the quarantine station system under the biosecurity umbrella of his fiscal 2005 budget request to Congress by calling for another 14 CDC quarantine stations at U.S. ports of entry. On December 8, 2004, Congress allocated $80 million to the Department of Health and Human Services, Office of the Secretary, to support and expand biosurveillance activities in fiscal year 2005 (U.S. Congress, 2004).
The Epidemic Intelligence Service (EIS) is the country’s critical epidemiology training service, combating the causes of major epidemics. Over the past 50 years, EIS officers have played pivotal roles in combating the root causes of major epidemics. The EIS was established in 1951 following the start of the Korean War as an early warning system against biological warfare and man-made epidemics. The program, composed of medical doctors, researchers, and scientists who serve in two-year assignments, today has expanded into a surveillance and response unit for all types of epidemics, including chronic disease and injuries. More recently, EIS officers have documented the obesity epidemic in the United States, helped states reduce tobacco use, and studied whether disease outbreaks were a result of bioterrorism.
The National Electronic Disease Surveillance System (NEDSS) is an initiative that promotes the use of data and information system standards to advance the development of efficient, integrated, and interoperable surveillance systems at federal, state and local levels. It is a major component of the Public Health Information Network (PHIN).Their mission statement is to detect disease outbreaks rapidly and to monitor the health of the nation. Facilitate the electronic transfer of appropriate information from clinical information systems in the health care system to public health departments. Reduce provider burden in the provision of information. Enhance both the timeliness and quality of information provided. Surveillance Systems collect and monitor data for disease trends and/or outbreaks so that public health personnel can protect the nation’s health.
How are avian, pandemic, and seasonal flu different? Avian flu is caused by avian influenza viruses, which occur naturally among birds. Pandemic flu is flu that causes a global outbreak, or pandemic, of serious illness that spreads easily from person to person. Currently there is no pandemic flu. Seasonal flu is a contagious respiratory illness caused by influenza viruses.
Statistics of Infectious Disease: Approximately one-third of Americans have been exposed to hepatitis A, and there are approximately 80,000 new hepatitis B infections each year. Tuberculosis strikes about 15,000 people annually and about 36,000 people per year in the US die from influenza.
There are approximately 900,000 people living in the U.S. with HIV or AIDS, and about 4 million people get chickenpox every year. Even though the measles vaccination is now available, nearly 90 cases of measles still occur annually, and whooping cough affects more than 7,000 people in the U.S. annually.
As a country, we can take steps to minimize our risk and exposure to infectious diseases, pandemics and bioteriorism by providing the public with ongoing educational programs, and by creating management plans that protect the public and health care providers from the most common diseases. But that’s just a tip pf the iceberg and may be too little too late because it’s not a matter of if, it’s only a matter of when will the bugs circling the globe will become a threat to our safety, your health and our national security
